Changes to residential care system needed for elderly

Issue date: 24 May 2010

Researchers from the University of the West England, Bristol and the University of Warwick are calling for changes to the UK residential home care system to ensure older people have a 'home for life' and are not pushed out to hospitals or nursing homes unnecessarily.

More funding to support clinical training of social care staff working in residential homes, and a new registration system with formal qualifications, are among the recommendations made in a new report funded by the Joseph Rowntree Foundation.

Deirdre Wild (UWE, Bristol) and Professor Ala Szczepura from Warwick Medical School led the study, which has evaluated the introduction of enhanced care for older people in three types of residential home.

The team compared a voluntary sector home, a privately-owned home and a local authority-owned home which all introduced 'enhanced residential care', based on developing new type of worker roles. Extensive fieldwork was carried out over three years and a total of 108 interviews were carried out with residents and relatives, care staff, home managers, senior managers and key stakeholders.

Survey questionnaires were also sent out to all staff; focus groups were conducted with care staff, residents, relatives and home managers; and activity data was collected across the three residential homes and a comparator nursing home.

In England, more than 18,000 care homes currently provide places for more than 453,000 residents. Six out of ten places are in residential homes with no nursing staff employed on-site. Three quarters of residential homes are privately owned. Residential homes employ some 230,000 care workers and senior care workers and this figure is set to rise with an ageing population.

Deidre Wild said, “The research findings support the view that good basic health/nursing care can be delivered in a residential home, provided there is a sound practice-driven relationship with community nurses, and that care staff know when to seek nurse-led support. Those responsible for development of the new role carer workforce should recognise that without incentives and recognition for the delivery of improved health and social care, these roles will become difficult to sustain beyond a 'honeymoon' period."

“We need to get the horse in front of the cart and professionalise the new carer workforce. This requires putting in place carer registration, appropriate formal qualifications, career pathways, and a robust accountability and liability framework to protect both new role carers and older people. Clarification of the nursing activities suitable to new role carers, how competencies are to be maintained, and the interface of the carer 's new role with that of registered nurses also need agreement at a national level.”

Fellow researcher Professor Ala Szczepura (Medical School, University of Warwick) said, “In future, cost-effective care of older people is likely to be reliant on extending the spectrum of care provided by residential homes. Our study found that nearly half of current residents can be classed as needing the intervention of a registered nurse on at least a daily basis. The development of a cadre of new role carers, combined with carefully planned support from community nurses, can enable these homes to provide high quality care as residents' needs increase. This can save the NHS money as well as improving older people's quality of life.”